Monday, 12 November 2018

Butter Nonsense

Posted by Martin Cohen

Last week saw President Trump throwing out a CNN reporter from the White House Press Pool for disagreeing with him about ‘the facts’.

CNN called it an attack on press freedom, but the collective response from other journalists has been muted. And no wonder, because these days the press are themselves heavily into ‘denying’ certain views. We've all heard about ‘Climate deniers’ and how evil they are, but this last month saw a vehement attack on Cholesterol deniers!

Sarah Boseley, longtime health editor of the supposedly liberal UK newspaper, The Guardian, launched the attack with a piece called:

‘A group of scientists has been challenging everything we know about cholesterol, saying we should eat fat and stop taking statins. This is not just bad science – it will cost lives, say experts’.

The back story is that The Guardian, has often seemed to look fondly on the pharmaceutical industry and regularly promotes the case for expensive drugs and mocks campaigners. Its longtime medical writer, Ben Goldacre, under the heading we just saw reused by Ms Bosely of ‘bad science’, regularly wrote in favour of Big Pharma and against alternative medicine let alone common-sense approaches without ever declaring his own links. There were family links as well as a career one via the Institute of Psychiatry to many of the industries favoured by the arguments in his articles.

‘Big Phama’, firms like Unilever; SmithKline Beecham and Pfizer Limited (two producers of antidepressant drugs); Novartis Pharmaceuticals (previously Ceiba Geigy); Lilly Industries Ltd (the manufacturers of Prozac); Hoescht Marion Roussell; GlaxoSmithKline (vaccine manufacturers) … and so on smiled on his work. Goldacre even received an award for ‘science journalism’ in 2003 - the award that year being sponsored by GlaxoSmithKline.

It’s enough to make you cynical, as is the fact that in the early years of 2000, the Institute of Psychiatry held over 200 research grants with an annual value of around £14.5 million. Its second highest source of funding was the pharmaceutical industry. The Institute is part of King’s College London, and part of the UK’s public education system. Yet for all the money the public devotes to universities, and for all the special status of university academics, private money like this drives research findings.

But back to butter, and the new money-spinner today is prescribing drugs called statins in order to reduce cholesterol. Justin Smith estimated in a piece for Statin Nation that the market for these drugs was more than $19 billion and rising. In The Guardian piece, Ms. Boseley says ‘statins are out of patent and therefore no longer make money for the companies that originally put them on the market’.

Note those ‘weasel words’, ‘for the companies that originally put them on the market’.

I looked at the cholesterol debate - I could hardly NOT do - in my food book published this month*. It is (chemically speaking) a very 'complex' area (all diet things seem to be when you get into them), but there are some studies that can be talked about in a broader sense, including several iconic long-term studies of low-cholesterol diets which do seem to demonstrate:

(a) that it is effectively impossible to isolate one factor in a dietary study, (alteration of one factor disguises changes in other factors too) and

(b) in as much as it is possible, not only that there is no evidence to support the 'low cholesterol diet' approach, there are indications that it might actually increase the risk of heart disease!

The Guardian piece makes little attempt to present a 'debate' but instead offers the view that there is an argument for refusing to give cholesterol-deniers a platform, just as some will no longer debate with climate change sceptics. The position is summed up by one of Prof Rory Collins of Oxford University, a professor of epidemiology who says quite unashamedly that by cholesterol deniers he means people who dispute the claim that diets high in cholesterol are dangerous for heart health. As Sarah Boseley puts it here, these are people saying butter is safe and statins are dangerous. BAD PEOPLE!

No real evidence is actually offered in the piece, and when I asked Ms. Boseley for any background studies she might have used, she did not respond to the request.

In fact, the available evidence is very different. One small study of Australian men found swapping from butter to margarine, for example, found the death rate from heart disease went up amongst the margarine eaters. Another study, in Denmark, that put people on a low-salt diet precisely to protect heart health, found that perversely it led to cholesterol levels shooting up!

Surveying the research, some 20 years ago now, Dr Laura Corr a cardiologist at Guys Hospital in London concluded that :

‘The commonly-held belief that the best diet for prevention of coronary heart disease is a low saturated fat, low cholesterol diet is not supported by the available evidence from clinical trials"

However, seven years ago, an influential meta-analysis by the Cholesterol Treatment Trialists found that:

In 2015, another systemic review by researchers from various international institutions in Japan, Sweden, UK, Ireland, US and Italy, published in the BMJ, insisted that - on the contrary! - as LDL cholesterol went down, all-cause mortality went up while higher levels of ‘bad ’ were apparently linked to living longer.

Don’t ask for new studies, as there have been so many, and yet analysis of what they prove remains completely partisan. It has been noted that the actual trial data held by the Cholesterol Treatment Trialists’ Collaboration on behalf of the industry sponsor has not been made available to other researchers, despite multiple requests over many years.

Since then, rather than demonstrate their case through persuasive research, advocates of the low-fat, low-cholesterol diets have sought to shut-down debate even trailing that new term cholesterol deniers...

After reading all the evidence, my feeling is that cholesterol levels are not simple, one dimensional values to be turned up or down like a thermostat and attempts to shoehorn it into a Manichean (good / evil) view of dietary factors risks actually harming human health. Attempts by governments and media to rule definitively on it are unwise and a distraction from practical steps that can be taken.

Thanks for the comments, Keith and Thomas. Yes, the 'media' certainly work to change all issues into 'simple one-D values' - and yes, as Keith says, soot do the experts, which is a more subtle phenomenon. Doctors and scientists, for example, seem to need to feel part of a group, and so become advocates for policies that they might better have offered only tentative guidance on.

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